Access to health care and health services: An in-dept formative evaluation of recent refugee women's access at the Massachusetts General Hospital (MGH) Chelsea HealthCare Center

Refugee women have unique health needs resulting from their experience with war, cultural and religious beliefs, illiteracy, poverty and resettlement stress. To determine the scope and factors that influence refugee women's access to health care at a hospital-run community health center, we conducted an in-depth assessment from May to August 2009. The assessment included a literature review, 115 patient record review, 25 interviews with refugee women, and 45 key informant interviews. Our findings confirmed disparities in accessing preventive care, preconception, perinatal and interconception care, chronic disease management and mental health services. Patients' records revealed low rates of recommended screenings. The rate of mammography screening was 58.9% for women aged 40 and older versus 84% in Massachusetts; Pap smear rate was 8.5% for women 24 and older and 13.3 % for those 13 to 23 years versus 92.1% in MA. The rate of chronic diseases was 54% (diabetes, obesity, and hypertension). Lack of data on health care utilization and outcomes for refugees and some immigrant groups was another area of disparity. The main barriers to care were lack of understanding of the health care system, language, cultural and religious beliefs and health seeking behaviors motivated by acute symptoms. Underutilization of mental health was due to stigma, low locus of control and limited capacity for culturally competent care. Finally, refugee women were burdened by basic needs and overlooked their own health. A newly developed intervention and strategies to respond to the identified needs and better coordinate care will be described.